Summary notes of Leeds KONP meeting “ The NHS Who Owns It ?” with John Lister on 14.4.21
JOHN LISTER made it clear that he was keen to spend less time describing the extent of privatisation in the NHS, which he covers in https://healthcampaignstogether.com/in5/Briefing%20pack%20update/
and more time talking about how we go about campaigning against privatisation in the current political climate, when we have our backs against the wall. These were some of his key points/messages.
It isn’t enough to campaign against private services on moral grounds; we have to show that privatisation doesn’t work, we have to call it out on quality and coverage. Test and Trace is a good example of vast amounts of money thrown at a highly ineffective service, compounded by wasting more money on management consultants ( some paid over £1,000 per day ! ) to try to rescue it. On a positive note the Imperial Health Care Trust, which brought 1,000 outsourced cleaners back in house on a temporary basis one year ago are planning to make the arrangement permanent as it is working well.
Meanwhile 40% of NHS cleaning services remain contracted out. John suggested that “outsourced” is a euphemism for bringing in an alien provider which undermines the integrity of the NHS, fragmenting not integrating services, creating instability, poorer staff conditions and lower quality of service.
It can be counter- productive as campaigners to define ourselves as trying to hold back the tide of an imminent takeover of the NHS by US private firms as it isn’t true ( in John’s opinion). He suggested that the US firms are after easy juicy contracts not wholesale takeover and imposition of an insurance based model. The NHS’s spend on health care is only a quarter to a third of the US spend so it is not that enticing for profit hungry companies, the firms that have taken on running large health care facilities like Circle rapidly found it wasn’t viable and private hospitals have on average just 50 beds. Similarly John suggested that Centene (Operose’s) takeover of 37practices ( 48 surgeries) in London is not part of a wholesale takeover of primary care. They comprise just 1% of practices, most of which do all their work for the NHS, not for profit. This doesn’t mean the fight against Centene isn’t important. On the contrary it means that Operose’s move is against the main grain and therefore more winnable if we put the work in.
Opposition is already gaining support from local Tory councillors as well as Labour.
persistently giving the message that the NHS is doomed and will collapse in the next few years is demotivating. If the battle is already lost what is the point in fighting?
It is too simple to say the Tories just want to privatise the health service. They don’t care about patients but don’t have a coherent position and know that openly trying to privatise the whole of the NHS, even if feasible, would be political suicide as the NHS remains very popular, particularly with older people where their vote is concentrated. They just want they and their friends to be able to continue to make money out of health. The contracts handed out to Tory cronies under cover of Covid, without transparency have given us some useful ammunition for exposing the underlying corruption including the revolving doors and intricate webs between the NHS, Government, private firms and lobbyists. Their enthusiasm for giving away data and promoting digital health care and a multitude of apps is also about generating profits for private companies.
We are currently stuck with the Tories who have a very comfortable majority and are benefitting from a vaccine bounce in popularity so there are no great hopes of getting what we want through Parliament. The best we can aim for e.g. in opposing the health White paper and Integrated Care Systems (what John called “Integrated Crony Systems or Services” ) is splitting the Tories by putting pressure on Tory MPs wherever we can, which isn’t something we have tended to focus on. There is genuine concern in some Tory councils about marginalisation of local government in the White Paper as well as over ICS boundary changes.
This means that that battles have to be fought and won issue by issue, locality by locality, doing the hard graft to expose how privatisation doesn’t work and fighting to get services which have been outsourced through Wholly Owned Subsidiaries or other means brought back into the NHS, particularly as contracts come up for renewal. We have had successes over PFI as well as cleaning and there is much to be done and won over social care, which John suggested has been the biggest chunk of privatisation of the NHS.
It happened in the 1990s following the Griffiths report, when hospital beds were closed and people sent into nursing homes. More recently the bulk of domiciliary care has been privatised too but again there have been some small local steps to end charging and bring some resources back into LA control. John also mentioned that mental health and community services are very reliant on private services. 44% of funding for child and adolescent mental health care goes to private companies, 30% of mental health hospitals are privately run. ( I don’t think we talked about the fact that campaigning against out of area placements pushed the issue up the agenda and forced some improvements and a combination of scandals and campaigning by disabled people’s organisations has had some impact on the institutionalisation of people with mental health and learning difficulties. )
We need to press local Integrated Care Systems on transparency (meetings and papers must be open to the public; they must be subject to the Freedom of Information Act) and on local accountability, as these issues resonate with local councillors and local people and transparency ensures that issues see the light of day and can be openly challenged. We need to expose the heavy reliance of ICS on major management consultancy firms like Deloitte, KPMG, PwC and McKinsey, who are designing and delivering “transformation” including workforce, digital ‘solutions’, data management etc., bringing significant influence of the “for profit” sector into health (of 83 companies approved by the Govt to assist with ICS, 76 of these are private and a number of giants are US based). John was sceptical about ICS members managing a single pot of funding without disagreement and getting into deficit. In some areas relations between partners are already fractious. We need to keep chipping away at ICS and smoke them out! He noted that there have always been swings in policy and practice. Push back can gather support and be effective.
To build public opposition to the erosion of the NHS we need to make issues understandable and tangible to people. There are a number of campaigns around the loss of resources and quality of maternity service which hit home with a wide range of people whom we haven’t always reached with our campaigning, including younger people. Reduction in personal access to GPs and high dependence on virtual/digital communication is another issue that concerns people and excludes many.
We have to look at what DRIVES privatisation and challenge these underlying issues
Long waiting lists result in the NHS giving more money to private hospitals and some people deciding to “go private” because they can’t wait any longer (JP noted a third of elective hip surgery is done in the private sector – paid for by the NHS). However we need to make clear that if patients have any complications they will be rapidly transferred into NHS beds because the private hospitals don’t have the facilities to deal with emergency, complex or critical care. The private sector relies on cherry picking straightforward, generally well patients – and on NHS trained staff!
Chronic shortage of hospital beds and equipment. John noted that at the start of the pandemic the NHS had significantly lower bed numbers than most EU countries but at end of last year had 14,000 fewer front line beds than 12 months previously because of Covid demands and restrictions. Now £10bn of public money is going to be channelled into private hospitals to tackle the waiting lists.
Long term underfunding of hospital maintenance, which has eroded the fabric of our hospitals and created health and safety issues. The £6bn shortfall pre Covid is now nearer £ 9bn. Recently people had to be moved out of wards in Kings Lynn because they were unsafe. The promised money for 40 new hospitals boiled down to some funding for six building projects which may or may not see the light of day ( including incidentally a new Children’s Hospital building on LGI site in Leeds which was already planned and appears to be going ahead ) plus just £5m seed funding for each of 34 areas, to explore the possibility of new build.
Staff shortages, which were dire before the pandemic with over 80,000 vacancies are now compounded by having 40,000 staff off sick, the potential impact of long Covid, burn out and stress, as well as the impact of Brexit and tightened immigration rules which not only cut off recruitment but have resulted in many experienced staff leaving the UK. Since Hunt promised 5,000 new GPs there has been a net reduction in GPs! A promised new 6,000 mental health professionals haven’t appeared either.
